Monday, December 31, 2012

5 Easy New Year's Resolutions

By Chiqui Raveloski

A new year is here and New Year’s resolutions are in the making. New Year's resolutions are a great way to think about the past, present, and the future. The year 2012 has brought us plenty of exciting and memorable events to remember by. From the discovery of a new particle consistent with Higgs Boson ( "The God Particle"), to the day 12/21/12, when the world was supposed to end, according to the Mayan calendar... we can now take a deep breath and say that we "survived" 2012!

No one knows what 2013 will offer. Yet, we can offer ourselves these 5 resolutions in order to gain a relationship with our mind, heart, and soul, fulfilling our individual potential.

1. Respect and Love. Respect one another. Each one has a story which is also unique to each individual. As nurses, respect for cultural diversity is embedded across our lifespan. We treat everyone equally regardless of race, religion, economic status, etc., preserving integrity. At the same time, we should also have self respect in order to grow personally and professionally. With respect comes love, and love is a universal language.

2.Honesty. Honesty is the best policy. "Mas masarap ang tulog mo pag malinis ang konsiyensiya". "You sleep better at night with a clean conscience". A good night sleep makes for a better morning. a better outlook, a better person overall. Similarly, nurses hold the responsibility of providing the best patient care and exhibit accountability for your own judgment and action.

3. Honor. Honor your heritage and the elders. Always look back to where you came from. This allows for better understanding of yourself and how to move forward. At the same time, elders have done this plenty of times in the course of their lives. They hold knowledge which we can learn from. If doing patient care and the day becomes unbearable, take a moment to step back and do a simple task of feeding an elderly patient. This can somehow block our senses from all the chaos and at the same time, reminding ourselves why we got into the profession. It is a feel good moment. Trust me.

4. Kindess. Be kind to one another. It conveys a giving behavior, pleasant nature, and genuine concern for others. It is a value we all grew up with. In a busy world that we live in, sometimes personal values are put to the side in order to keep up with the times. We have heard of random act of kindness. Let us join in the movement. It can benefit both givers and receivers with feelings of contentment and relaxation.

5. Karma. What goes around comes around. A cause and effect, action and reaction. Do unto others as one would want others to treat one self. It is a golden rule. This goes back to respect and love. Respect for human dignity and uniqueness of each individual. This might be the most challenging resolutions of all. Everyone does not believe in Karma, which I respect. However, if we just find it in our hearts to at least make the "world go around" one day at a time, is a favor we can do to ourselves and society.

It has been said plenty of times that "people don't surprise me anymore". This is true. Yet, I still believe and have hope for humanity. These 5 resolutions do not cost a penny. They are inflation - proof! Each one of us possesses these traits. You might have to be put in some really tough situations to find out. And if you do find out, take a moment and use it wisely.

Aging caring for the elderly

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Sunday, December 30, 2012

A Different Kind Of "Failure"

By Chiqui Raveloski

Boxing has been a major and popular sport in the Philippines as far back as I can remember. It has brought many Filipino greats like Pancho Villa, Flash Elorde and Ceferino Garcia. In the midst of all these great athletes, more famous boxers had entered the arena searching for the greatest fight of their lives. One of them is,  Manny Pacquiao, who has dominated the boxing world  for the past 10 years

Pacquiao's life story had been unraveled right before our eyes. From his humble beginnings, his dreams, and all his hardwork to attain the ultimate success. Consequently, his popularity in the Philippines earned him a seat in the congress, landed a few acting roles in the movies, and he even recorded a few albums to say the least. His rate of success was unstoppable that he was even named   "Fighter Of The Decade"  by the World Boxing Organization.

Everyone knows Pacquiao does what he loves to do. His performances during the fights all came too naturally. You can almost say that he was born a fighter! Yet, can we honestly say that he was fighting the right fight, or was he fighting to please everyone?

Pacquaio's latest losing match to Juan Marquez brought a sudden halt to his success.As a result it gave a good number of his followers some doubt toward his abilities as a fighter. It is all but natural to feel this way. Losing in this magnitude is not an option. This is especially true when huge amounts of money and fortune are at stake.

More at stake is Pacquiao's popularity, not only to the Filipinos but all over the world. He is a well liked celebrity because of his love for the sport, his family, his community, and to his country. In addition, his trainer Freddie Roach, also described him as a very giving person, a human ATM. But was he well liked because of his fortune, or is it because he is the down to earth Manny?

With all that is at stake, one cannot imagine the pressure sitting on Pacquiao's shoulders. Only fewer than most had been in this position. Taking a deeper look into what his journey had presented, draws the attention not only on the physical aspect of his chosen sport, but also the psychological, social, and spiritual components as well.

As many described it, Pacquiao's latest match with Marquez was marked as a failure. This, I believe is a different kind of failure. It is the kind of failure that teaches true stength, courage, and personal value. It is sort of a life detour. To take time out and re -examine the plan. The same goes in the world of nursing. As nurses, if outcomes are undesirable, re-assessment of the situation is a must in order to plan for better interventions, thus , comes favorable outcomes.

During this past 10 years, we can almost feel the punches he took, witnessed the blood streaming down his face, and the pain he endured to give us the fight we all wanted to see. Instead, Pacquaio gave us Filipinos the true meaning of our heritage ......bravery. "Ang naglalakad ng marahan, matinik may mababaw". "He who walks slowly, though he may put his foot on a thorn, will not be hurt very much.", a quote from a Filipino national hero,  Jose Rizal. Let this sudden halt remind us of the same bravery which inspired most to do better,  and be of value not only to yourself but to society.

 HBO Boxing Gratest Hits:
A look at Manny Pacquiao's career.

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Wednesday, December 26, 2012

Progress And Challenges In Nursing

By Chiqui Raveloski
Progress is an ongoing trend in the world of nursing. Advancements has been made as more nurses engage in managerial positions, advanced nursing practice as part of primary care setting and doctoral prepared nurses engaging in research. As evidenced based practice becomes more as a basis for patient care, research can be a key to improving health across the lifespan. Yet, time and time again, nursing is still confronted with several key issues which can have the potential to impact nursing of today and of the future.

A key issue that comes to mind is the societal changes. Population shifts in America present challenges in the healthcare industry. Nursing has seen longer life expectancies with increasing number, severity, and duration of chronic illnesses. Such chronic illnesses which also originate from different socioeconomic levels demand specialized plan of care. Caring for patients are further dictated by managed care, government assistance, or merely lack of healthcare insurance.

With the surge of population that has severe chronic illnesses, the demand for more nurses is still in the forefront. As a result, nursing shortages impose a negative impact in patient care. Nurses are often thrown in a dangerous position of caring for high acuity patients at a higher nurse to patient ratio. This scenario is too rampant in all healthcare settings. Subsequently, new nurses who enter the profession experience early "burn out" and “baby boom” nurses leave the profession to retire.

As “baby boomers” and “burned-outs” leave the nursing profession, the rise of the “one call that’s all” generation is far too common. More nurses are being named in lawsuits and awards to plaintiffs are outrageous. The increase in lawsuits and awards to plaintiffs increases overall healthcare cost. At the same time, individuals who are looking at nursing as a career choice and nurses presently practicing second guesses the choices made.

While more challenges present itself in the nursing arena, the fight for the ultimate resolution remains to be yearned for. This yearning push nurses to search for solutions through critical thinking. Yet, if critical thinking is applied to the progress and challenges in nursing, a key assumption can be made, in yet another key area that needs contemplation. This is the lack of a common ground when it comes to the educational standards for entry level in nursing practice- Associate of Science in Nursing vs. Bachelor's Degree in Nursing. More debates, controversies, and arguments about this platform bring more agitation to an already high stress profession.

Searching for the common ground in the educational standards further divides nurses in various spectrums. At the same time, this also creates confusion for individuals who are thinking about entering the profession. How can the nursing profession support progress when even the entry level standards are not organized?

Nurses strive for outcomes that are measurable, specific, realistic, and indicate a timeframe for achievement. Realistic outcomes are possible once collaboration and readiness are identified. Time is of essence in resolving the issue, but, is time running out as the increasing complexity of patient care demands for highly qualified nurses.

Challenges dictate progress. Progress requires sacrifice. If a common ground can finally give the nursing profession the unity it most aspire, are nurses prepared to sacrifice beliefs, value, and comfort level when it comes to the education issue? Is the profession ready to withstand progress as bigger responsibilities and higher standards becomes the theme of success?


Friday, December 21, 2012

Christmas Traditions

By Chiqui Raveloski

Christmas is one of the biggest holiday seasons in the Philippines. I remember growing up looking forward to celebrating Christmas with all the traditions that goes along with it. It officialy starts on December 16  with "Simbáng Gabi" , Night Mass. Simbang Gabi is a nine -day series of Catholic Mass in honor of the Blessed Virgin Mary.  It is usually done as early as 3 to 5 o' clock in the morning. Luckily, Mom did not require all four of us kids to participate in this tradition. Can you imagine waking up at 2 am in the morning for nine days ?!! It ends on the morning of Chritmas eve , it is called "Misa de Gallo" , which literally means “Rooster’s Mass”
“Bisperas ng Pasko”, Christmas eve night, is when the fun starts. I remember anticipating the opening of gifts after attending the midnight mass. Then, we dine together after mass, on yet another traditional Christmas meal called Noche Buena"  feast. which includes: "queso de bola", Spanish: "ball of cheese"," tsokoláte" , Hot chocolate, "pan de sal", Filipino fresh bread, (yummmmm),  and "hamon" Christmas ham.
Christmas day in The Philippines is a especially huge family affair. We would visit relatives, and pay respect to the elders. “Pagmamano” which is done by bringing the elder's hand to one's forehead, while saying the phrase "Máno Po" , hand please,  is a custom of giving respect and an age-old tradition .The elder then blesses the person who has given their respect, and in return gives "Aguinaldo". money in fresh bills. Godparents are especially socially obligated to give presents to their godchildren. A christmas lunch usually follows after the “Pagmamano"

After 26 years of living here in the United States, I cannot help but still think about those fun and memorable Filipino traditions every Christmas season. As a matter of fact, during the fiirst few years of living here in the United States, our mother tried to stick to some of the traditions , paying attention to the Catholic mass and Noche Buena. Yet, life and living here is different and sometimes, compromises has to be made in order to somewhat preserve the values learned from these customs.

Now that I have my own family, traditions are further “tweaked” in order to start our own. Keeping in mind that the same important values are shared and passed on to our daughter, not only during Christmas, but all throughout the year.

So, during this holiday season, let us remember all the wonderful things we used to do growing up, when life were a bit simpler. Even to those when life had been specially tough growing up, remember the lessons and values learned from it. To all my family, friends, and “kapwa Filipinos”, fellow Filipinos, "Maligayang Pasko at Manigong Bagong Taon", Merry Christmas and a Happy New Year.

Filipino Kids Christmas Caroling

I wanna make one!

Wednesday, December 19, 2012

Nursing and Parenting

By Chiqui Raveloski

Nursing is an emotionally charged profession. It requires a great deal of self discipline and self control to remain focused to the tasks and challenges that waits. With this in mind, values and beliefs are always at stake especially when emotions are at a high. This can drain and exhaust anyone and adaptation is a must. Nursing is like parenthood. It is complicated yet rewarding. A day does not go by without learning, loving,  and nearly losing one’s mind.

A nurse’s day begins with a challenge once entering the work area. A full load of patient census is in the picture. This can include caring for an elderly adult with a diagnosis of altered mental status. Similarly, parents face the challenges of parenthood upon the arrival of a new baby girl or boy in the family. Both nurse and parents readily feel the sense of responsibility and  

As the day progresses, the nurse use care plans and trust instincts, as a guide on how to care for all the patients. The nurse constantly tries to re orient the older adult of the situation while cleaning up the wet briefs.  Parents on the other hand, complies by the “newest” parenting book in the market, advice from friends , and “gut” feeling on how to raise their new bundle of joy. They do this while changing diapers every two hours.

The nurse shows compassion while comforting the flustered and confused patient over a spoon that fell on the floor. Likewise, parents find comfort while soothing their child’s forehead with kisses reassuring that everything is going to be alright.
The nurse continuously prioritizes the care of patients exhibiting her flexibility, competence, and courage. Each patient’s needs are met in between phone calls from physicians, critical lab values, hanging blood transfusions, initiating antibiotics, and responding to patients' change in condition. Comparatively, parents exhibit their talent in juggling as they maneuver through  their busy schedules. A day off from work starts with a sick visit to the pediatrician, get home at a certain time so the plumber can get in the house to fix a busted pipe in the laundry room, cook dinner, and clean the house while holding and hugging the sick child.
Nurses use the Nursing Process as they think critically through different situations. While doing so, personal values and beliefs guides nurses in their decision making. Yet, there is no amount of training that can influence one’s values and beliefs. Values are learned and chosen by individuals as they journey though life. "Ang kalooban at konsiyensiya ng nurse ay malinis". And nurses find strength knowing that their inner self and conscience remains clean. 
Personal and professional values can only be enhanced and shared in the course of the nursing profession. While nurses endure their emotionally charged profession, personal and professional values are simultaneously intertwined to achieve the desired goals.
Each experience a nurse comes across is unique in its own way, no matter how small it may be. These experiences only reveal a nurse's strengths as well as their weaknesses . These revelations can simply teach nurses how to be accountable and responsible for their own actions towards self, others and institution.
As for the parents, putting their child in bed and saying their "goodnight" and "Mahal kita", I love you, brings warmth and joy in their hearts. The nurse on the other hand, ends the shift with the not so new patient saying, “thank you for everything you have done for me” , brings contentment and pride in the chosen profession.

Tuesday, December 18, 2012

A Simple Gesture

By Chiqui Raveloski

It was the usual start of the night shift at the hospital. The day nurse gave the report for the 6 patients and everything seemed well. Except for the one patient, who will be referred to as CY, 71 years old, who  has the possibility of making the night shift very interesting.

What's so interesting? CY had been mad about everything. There has been a lot of yelling, screaming, complaining, and even "cussing" , not from the nurses ( ha, ha), but from CY. It had gotten so bad, other patients from the same hallway are requesting to be moved to the other hallway or a different floor.

So, just like any other shifts, a game plan was formulated, prioritization is going to be key, and maybe a special kind of TLC is in the works. The first phone call 15 minutes into the shift was from CY,  complaining about the door being shut all the way through, things were moved around making it  hard to reach, and no regards for one's personal needs. CY"s voice was demanding, frustrated , yet familiar. It is a voice nurses get accustomed to as  - someone who is scared, in a strange environment, needing reassurance.

The door to CY's room was cracked open. The room was clean, in order, and well lit. The bedside commode, bedside table, call light,  and phone were all within reach. CY's facial expression was one of aggravated, tired, and anxious. Introductions were made and CY started complaining about how miserable it has been. As a result, a plan for the night was made which included pain control, leaving everything within reach, crackers for snack at the bedside, and leaving  the door propped open in a special way because CY is also claustrophobic.
 A therapeutic communication was also started. Patients need acknowledgement. CY then started to calm down and asked for assistance to the bedside commode. In the meantime, the bed was straightened, sheets were positioned nicely, and a fresh pillowcase was set for the night. One more thing, the pillow was "fluffed" several times before placing it at the head of the bed.

When  the fluffed pillow was placed down, CY looked at me with a smiling face and said, "O dear, I did not know you can fluff those pillows. You are the first person that did that for me, Thank you so much!" I replied. "You are very welcome. I want you to have a good night sleep with pleasant dreams". CY was assisted back to bed and the look of content was reassuring, but this time, on my part.

The rest of the  night went by smoothly. "Salamat sa Diyos" , "Thank God" for the guidance. Other patients were taken care of designed to their own specific needs. Physician orders were implemented, lab results were checked,  medications were given safely, and charting were done. There was only one phone call from CY. To thank me again for everything I have done.

Monday, December 17, 2012

Walang Pasensiya, No Patience

By Chiqui Raveloski

What has happened to taking time to get things done instead of being in a hurry to get the same result at the end? Like, driving within a speed limit and an impatient driver "tail gates", then passes, only to get to the same stop light earlier?

"Walang pasensiya, palaging nagmamadali!", simply no patience and always in a hurry! This behavior has gotten so rampant to the point of society losing touch of one's self. People have gotten "linked" to their favorite electronic gadget (s), dependent on its "features", and merely forgetiing one's self virtues.

Patience is a virtue. It makes better persons in the long run, Patience has no room for "instant gratification"  It is by all means  to tolerate delay, and  exercising  self control. With this in mind, results of "walang pasensiya", and "instant gratification" are seen in the patients in the hospitals.

People want to lose weight right away, takes the popular diet pills, and ends up in the hospital with crazy heart rhythms. There are some who choose the gastric bypass, and ends up with intractable nausea, vomiting and sometimes diarrhea. For many, merely giving up a new healthy Type 2 diabetes life style, to iimprove one's mind and body, results to kidney damage, stroke, or leg (s) amputation. Unfortunately, to some death cannot come any quicker, like "walang pasensiya".

The  introduction to this blog cannot be further from the truth as it does confirm  that "Tail gaters" do get to the stop light earlier than the ones who stop and smell the roses .

Bahala Na in Nursing

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By Chiqui Raveloski

"Bahala na" is Tagalog/Filipino for  whatever will be will be. Bahala na is an everyday remark or simply a way of life that we Filipinos had learned to embrace and live by. . It is a mantra, a words of wisdom of some sorts. 

Yes , I am a Filipino, born and raised in Manila, Philippines , and have lived in the USA for the past 26 years. Yet, the bahala na attitude is still strong and has helped me survive the many obstacles that came my way.

I am a nurse and the "bahala na" attitude is somewhat unorthodox in the nursing practice. Nurses use the Nursing Process effectively with outcomes that are measurable. Nurses just don't say whatever will be, will be.  This is crazy ! !

As crazy as it sounds, the Bahala Na attitude has helped me make sense to things that I do not have any control of. Say for example, the ever so popular problem in nursing - the nurse to patient ratio. On a regular day, we are so short staffed that I would have to take care of 6 to 7 patients in a 12 hour shift. I am sure that a good number of telemetry nurses out there would say, " That is too many pat

I don't have any control of how the staffing will turn out. At the same time, as to  how many patients will come to the hospital. One thing I know I can control is my mind set and attitude for the day.

When I say "Bahala na" I live it all up to the higher being to guide me, to  keep me and my patients safe. Implementing nursing interventions to the best of my abilities , not compromising patients' safety. At the end of my shift, it brings a smile to my face knowing that each of my patient is safe and free of harm